Who Is Doing Advance Care Planning in Nursing Homes?

When I was an ED nurse in a city hospital years ago, we often received patient transfers from area nursing homes. Usually these patients were very elderly, appeared cachectic, and were largely unresponsive (as I recall, many were post-stroke or had dementia). Diagnoses were usually very similar: dehydration, hypotension, UTI, pneumonia; many had contractures. The usual care was rehydration with IV fluids, an NG tube, antibiotics, and often a Foley catheter. Sometimes they were septic and then they were intubated, placed on ventilators, and sent to the ICU, where just about everyone died after a short stay.

What’s the point of this care?

I often wondered, as did many of my colleagues, what was the point of this. It seemed futile, and injurious to the patient. Sometimes, if we could reach family members before nasogastric or endotracheal tubes were placed, we were able to secure an order to dispense with all but comfort measures. Otherwise, all measures were initiated and then things became complicated—legal issues arose about discontinuing futile care and families often couldn’t bring themselves to discontinue life support measures.

Today, a greater focus on advance care planning.

Advance care planning (ACP) was hit or miss in those days—mostly miss—and our patients suffered because of this. It’s only recently that emphasis has been placed […]

2018-12-10T11:07:41-05:00December 10th, 2018|Nursing|0 Comments
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‘No Illusion of Forever’: A Mother and Nurse Makes Every Day Count

As a nurse in my early twenties, I worked with kids with cystic fibrosis (CF). At that time, we were just beginning to see some teens and young adults in our CF clinic. I was close to them in age, and friendships naturally developed. Some never even reached their twentieth year. I had never seen people my age die, and although as a nurse I knew this was possible and even likely because of their illness, every death was shocking to me.

It’s hard, then, for me to imagine how it must feel to have siblings with a terminal disease. It seems to me that losing just one brother or sister early in life would be devastating. What if you watched six die?

A childhood punctuated with loss.

In this month’s Reflections column, “No Illusion of Forever,” author and nurse Elizabeth Bruno shares her memories of her time with the brothers she lost to agammaglobulinemia. The earliest death was a brother who died at ten years of age; the longest living was her oldest brother, who lived to the age of thirty.

Part nurse, part mother—always remarkable.

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2018-12-06T14:38:20-05:00December 6th, 2018|family caregiving, Nursing|0 Comments
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Managing Movement Disorders: Spasticity, Clonus, and Muscle Tightness

Do you know how to help people with muscle tightness, spasticity, or clonus? And what if someone has more than one of these conditions at the same time?

Little information in the nursing literature.

 

In “Managing Movement Disorders: A Clinical Review,” their CE article in this month’s AJN, Rozina Bhimani and colleagues provide an excellent guide to the assessment and pathophysiology of, and treatment for, each of these conditions. There is very little in the nursing literature on their management, so this article by nurse experts who work with these symptoms every day is particularly enlightening and helpful.

The authors point out that muscle tightness, spasticity, and clonus are not always interpreted accurately by clinicians. This can lead to less-than-optimal treatment.

“Neuromuscular signs and symptoms occur across a multitude of diseases and injuries . . . . Successful symptom management requires effective communication about symptoms, yet there are often discrepancies between patient and provider descriptions of neuromuscular symptoms and manifestations.”

[…]

2018-12-06T14:36:23-05:00December 4th, 2018|Nursing|0 Comments
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40 Million and Counting: These Days, Every Month Is Family Caregiver Month

Family caregivers, unpaid and unsung.

Photo courtesy of AARP Public Policy Institute.

November is, among other things, the month designated as family caregiver month. These are the 40 million or so people who provide care to loved ones at home, often by themselves. This can range from the basic tasks of daily living that a loved one can no longer perform by themselves, like bathing, dressing, and eating, as well as complex nursing care involving injections, wound and ostomy care, and more.

Helping nurses help the helpers.

In this season of short days and family holidays, it seems like a good time to remind you of the free resources AJN has for nurses and for the caregivers whom you work with. We’ve developed these articles and teaching videos in a decade-long partnership with the AARP Public Policy Institute directed by Susan Reinhard, and with the Betty Irene Moore School of Nursing at the University of California-Davis.

Teaching videos and tip sheets to share with caregivers.

Each article covers the evidence behind what and how you should teach a caregiver on a particular topic and is associated with a video demonstrating techniques and procedures for the caregiver to follow. […]

2018-11-30T10:14:08-05:00November 30th, 2018|family caregiving, Nursing|1 Comment
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‘So Many Things a Pill Can’t Solve’: An Integrative Therapy Nurse in Acute Care

“I don’t think that people realize how powerful human touch can be.”

“This therapy is invaluable to me—not just physically, but for my mental state too.”

“I think that we as Americans need more of this [integrative] therapy because there are so many things that a pill can’t solve.”

This is some of the feedback offered by patients after massage therapy sessions at the Minneapolis Veterans Affairs Medical Center. In this month’s AJN, integrative therapy nurse Hallie Boyd describes how her program has become a vital part of symptom management on the spinal cord injury and disorders unit there.

Help for patients in coping with chronic pain.

As a staff nurse on this unit, Boyd had encountered many patients who were trying to cope with chronic pain. While the hospital had long educated nurses on the use of integrative modalities such as guided imagery, acupressure, and aromatherapy, it was difficult for them to employ these techniques on a regular basis during busy and unpredictable shifts.

So, while continuing her work on the spinal cord unit, Boyd returned to school to focus on hospital-based therapeutic massage for medically complex patients. Training alongside a diverse group of practitioners, she developed and refined the idea of a full-time integrative therapy nurse as […]

2018-11-28T11:01:10-05:00November 28th, 2018|Nursing|1 Comment
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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